Newborn Enrolment with General Practice Bill

Thank you, Mr Speaker. I’m delighted to take a call on the second reading of the Newborn Enrolment with General Practice Bill.

It appears that two patterns are emerging out of this Government in its approach to legislation. One is an aversion to targets, albeit this aversion is somewhat equivocal. We’ve had examples of where there has been dispensing with targets—

💬 Hon Kris Faafoi: I know where there’s one target—the chair to your right.

Well, that may be true, but the radar is well off, Mr Faafoi, I think—well off. We’ve had Better Public Services targets where the previous Government had worked really hard to set an ambitious target for what it saw were really, really important measures of improving the lot of New Zealanders. Of course, we’ve had the national health targets, which were introduced by the previous Labour Government in 2007, and which have somehow been swept under the carpet for the foreseeable future. But it is equivocal, and I mention that in the context of child poverty reduction because, whereas health targets were not necessary or appropriate in the mind of Dr Clark, apparently, according to the Prime Minister, a child poverty reduction target is absolutely vital, to the point where the Government is introducing legislation to give effect to that.

Now, this bill is, in itself, a target. The target is to have 100 percent—all—of our newborn babies enrolled with general practice after their birth, and I think that’s a really, really important target, particularly when we’ve heard, as a select committee, that up to a third of our newborn babies are not being enrolled in general practice. That’s important, because the Health Committee heard from a number of submitters on this, not the least of which was the Auckland Regional Public Health Service, and Dr Felicity Goodyear-Smith was quoted in research that she did, when she talked about a study that found that non-enrolment of infants at birth with a general practice is a significant factor in delayed or missed immunisations—notably, “infants with no nominated general practice significantly reduced the overall coverage rate for the region, making”—interestingly—“the general practices look as though they were performing less well than they were.”

Indeed, the report from the Auckland Regional Public Health Service went on to talk about not only supporting this bill and its goal of ensuring that 100 percent of our newborns are enrolled with general practice; they went on to recommend that the scope of the bill be widened to include provisions requiring the lead maternity carer to notify the nominated general practice that a woman has booked with them to receive pregnancy care—that’s not presently a requirement; it’s certainly best practice—and they went on to say why that was important.

Now, the Ministry of Health gave us data on the number of newborns that were enrolled, which surprised me, I have to say, in how low they were. Then they also explained why this could be difficult for general practice. One of the reasons was a lack of familiarity with the family—which is quite right—but surely it is a reason to require this, not to not require it, because if one enrols the newborn, by connection other siblings and the newborn’s parents are almost certainly going to be enrolled as well. When we think about the sorts of preventable illnesses that occur when families are not connected with family practices, that strikes me as an extremely important and necessary step.

The ministry also told us that this bill, in their view—and this was kind of parroting the Labour position—was not necessary because they were going to set targets for district health boards (DHBs) to achieve themselves, only the targets that they mentioned were incredibly flaccid. As I said, we’re already at somewhere in the region of 67 or 68 percent—not nearly good enough. They wanted to set a target for DHBs of 55 percent for this year.

💬 Dan Bidois: That’s too low.

That’s far too low—so a six-week target that’s fully 12 percent less than what we’re doing without setting targets. Well, that hardly strikes me as something that would be aspirational, and it leaves nearly half of newborns not in the target for enrolment.

So this was a good idea. It needn’t have cost much. The sanctions for non-compliance were reasonably light, but it set a really clear expectation that this Parliament supported and wanted to lift the health of our youngest—our, arguably, most vulnerable—at a time when they needed the care of family practices the most. It’s really disappointing that after supporting it at first reading, when they had the chance in Government to continue to collaborate with the Opposition and with Dr Parmjeet Parmar, who came up with a really good idea, the Government has, in its infinite wisdom, decided that this is not important to them. It is not a priority that our newest New Zealanders—our youngest; those needing healthcare the most, with immunisations and health checks in their early weeks of life—would not be supported by setting a clear expectation that their enrolment with general practice was necessary and appropriate. It is, indeed, extremely disappointing.

We have a few speeches to go. I hope the Government parties can find it in their hearts to support a sensible bill that will improve the health of these babies, and I hope we can still do that.

Just before I call the member, I just apologise that the time clocks have gone out in the Chamber, but you can rest assured that I will let you know when your time is getting close.

Kia ora. Thank you, Madam Assistant Speaker. It is my pleasure to speak on the Newborn Enrolment with General Practice Bill as the chair of the Health Committee and to acknowledge, in the first instance, Dr Parmjeet Parmar. She engaged with the select committee in a very robust manner. She attended as many select committee meetings as she could. She heard from submitters. I think we engaged in a genuine process of trying to understand what her intention was but also what was already happening within the health system, within the health sector, to address the purpose of her bill, and I will read out some of the Health Committee’s report. The bill’s purpose actually was “to increase immunisation rates and to promote the early detection of any health or social problems” via being enrolled before immunisations are due at six weeks of age.

So the intention of the legislation, as my colleague Michael Woodhouse has already highlighted, is very good, and in fact I do want to acknowledge that we did support it at the first reading. Currently, the Ministry of Health has a target which is that 95 percent of newborns will have had, by the age of eight months, the primary course of immunisations: the six-week immunisations, the three-month immunisations, and the five-month immunisations. So already built into our immunisation system and the immunisation targets is actually a three-month lag, and so what we acknowledge is an issue within the system about the timeliness of immunisations, and I do want to acknowledge that the best way to ensure that our babies are being immunised on time is for them to be captured within a system. So I acknowledge that. The select committee acknowledged that. The ministry acknowledged that. Everyone did. But I think it then becomes incumbent on us to look at what the system’s actually currently doing.

The two performance measures that the Ministry of Health committed to through the select committee process, to fulfil some of the obligations we have to make sure our children are registered with a GP and do receive their immunisations in a timely fashion, were related to the performance measures that the ministry currently oversees through the district health board (DHB) annual plans. Through those DHB annual plans there is engagement through primary health organisation (PHO) service agreements, and they would ensure the reporting and monitoring via the National Enrolment Service for the system to actually work.

So the commitment we got from the ministry was that we needed a more joined-up system where the ministry was clearer about what the objectives we’re seeking were and they then directed the DHBs. The DHBs would then direct the PHOs, and then the PHOs would actually have some of those conversations—which my colleague Michael Woodhouse just highlighted—about who the families are. We were aware, through the National Enrolment Service and the coordination of the system, who was in the system, who wasn’t in the system, and what we could do about it.

So the ministry did propose targets of 55 percent enrolment by six weeks, and I just want to note that in 2010, the enrolment rate for six-week-olds was less than 1 percent, and, at that time, the enrolment rate for three-month-olds was 50 percent. So that was the other part of the commitment from the ministry—that they would set a target of 80 percent enrolment by three months. I say this to highlight those systemic solutions, because, in fact, the ministry has been working on this issue since 2012, under the previous Government. They actually implemented a preliminary enrolment policy, and that policy actually enabled the pre-enrolment of babies after notification from the National Immunisation Register. So the issue of enrolling our babies early with a primary provider, making sure they were in the system so that they could receive immunisations and actually enjoy being in a system where we’re going to detect any health and social problems, has been a focus of the ministry for a long time now.

So, I guess, then, we considered the proposition of this bill and actually legislating for health targets. We do have to wonder whether or not this is the best mechanism. Imagine if we have to do that for every health target: have a piece of legislation, go through the process, and actually find out what the ministry is already doing, as opposed to working with the ministry and, I guess, holding them accountable—and we have committed through the Health Committee to actually hold the Ministry of Health accountable for the implementation of these objectives and this regime of PHO service agreements and DHB annual plans. We have committed as a select committee to asking for regular reports from the Ministry of Health, so I think we’re fully justified in not supporting the bill. But now that I can actually acknowledge Dr Parmar, I would like to say that I commend her for her focus on children, and for wanting to enhance the beginnings of life for our children.

We know, and I know, actually, through previous work on the Health Committee, that the first 1,000 days of a child’s life are incredibly important. So what this bill was aiming to do, which was to make sure that every single New Zealand child was enrolled and was receiving the care that they need, was valuable and it’s something that we’re committed to, but I think the mechanism of doing that—and particularly within an interesting context. We did have some discussions about the fact that at the end of the day, parents can choose not to enrol their child. This bill in no way wanted to address that, because if we really wanted to, we could have made it a legal requirement for a parent to enrol their child at six weeks of age. It was discussed, and it was something that the committee—and particularly the member in charge of the bill—didn’t want to do, because we didn’t want to then have to enforce that and create a regime where, potentially, parents were going to be breaking the law because they didn’t enrol their child.

So we had some very interesting discussions at the select committee. We also had discussions about capacity and the fact that sometimes a notice had been sent to a particular provider about taking the child but, because of capacity issues, those providers couldn’t take the child—and then whose responsibility was it to follow up? So I think we’re reassured, as a Government, because of the commitment that the ministry has had in this area since 2012, and because of the commitments that they gave the select committee. I want to credit those to the member in charge of the bill, because we wouldn’t have got those commitments out of the ministry if this bill wasn’t presented to the House.

So I would like to say that the member in charge of this bill has created good change, and that good change will see more children enrolled with a provider so that they can receive the care that they need. Fundamentally, we disagree with health targets being legislated for, but we 100 percent support the purpose, the intention, and the rationale of why our children need to be enrolled and cared for by our public health system. Kia ora.

Thank you, Madam Assistant Speaker. Tēnā koe. It’s my pleasure to stand on behalf of New Zealand First and speak on the Newborn Enrolment with General Practice Bill. It is my pleasure, on behalf of my party, to do so.

I would just like to begin my contribution on this and acknowledge my colleague from Labour Louisa Wall for her work inside the Health Committee. Not being on that committee, it was interesting to hear your kōrero this evening about the processes you went through on the select committee, and just noting the amount of work you did on this bill and also the fact that the ministry has already been working on the enrolment of babies and getting that into a timely manner and also to help in that process of detecting any health issues that may come by having children and newborn babies enrolled in an early time frame. I also, too, note that the committee has asked for regular reports to come back from the ministry as we proceed into the future, ensuring that we get as many babies enrolled as we can.

Babies—they are amazing. All of those in the House who are parents know that when you have a brand new baby, it’s like the beginning of all things. It’s the wonder and the hope and all those emotions and all that untapped potential, all wrapped up inside that bundle of joy. That’s a really beautiful space to be in—inside that baby bubble—and we know that the Rt Hon Jacinda Ardern, in fact, in the last few weeks has experienced that and shared that with all of us here in Aotearoa New Zealand.

Just looking at this bill, the Newborn Enrolment with General Practice Bill—what actually will the bill do? It will ensure that the newborns are enrolled with their general practice and a primary health organisation (PHO) before six weeks of age. Now, that is, coincidentally, a very critical time in a baby’s life. It also coincides with that first immunisation, for those parents that do choose, in fact, to immunise their children. It kind of streamlines all of that process. That lead maternity caregiver—maybe it’s the midwife—will consult with the family and have a discussion about what kind of GP they think their family should be part of and where their newborn baby should go, and then they will send off that pre-enrolment form to connect with that general practice or primary health organisation. That GP organisation then has two weeks to ensure the enrolment takes place, and if for some reason they aren’t able to have that baby be part of their practice, then they’ll be required to assist that family in finding another general practice in which to enrol, and that should really be somewhere close to the residence of where that newborn baby is.

So that is, literally, the bill in a nutshell. New Zealand First supported the bill to select committee. However, unfortunately, now we will oppose the bill, based on the findings from the select committee. This really is a credit to the democratic process and the input that we’ve had in the select committee through the key industry stakeholders.

I’d just like to look at some of those submissions that came in, and I note that, yes, there were a number of submissions in support of this bill. As someone—and I’ll just read out a couple here now—who has been a new mum three times, this person wanted to say that “this is a really nice idea. However, getting out of a house with a newborn [baby] can be very difficult and even harder if there are older siblings to take.” That puts a lot of strain on the mother, finding it a little bit of hard work to get out, and particularly for some mums who end up being in hospital for an extended period of time if there are some complications with the birth of their baby or with the baby itself.

Another submission said it was very sensible and very practical “When GPs first make contact with the parents that they make them aware that visits for children are free of charge,”. Now, that’s really important. Some people aren’t aware that they can have free medical care for their babies, and, if there is a charge, what that cost is. So those facts are before the family right from the get-go, and that can allay a lot of fear for some of those people.

There were other submissions which were not in support of this bill—they were against the bill. One here says that “This bill concerns me as there needs to be an option to make the informed decision not to [enrol with] a GP at all as one of our human rights is to make our own decisions around our health and the health of our children free of coercion. If we’re forced to [enrol] our children with a General Practice our rights are in jeopardy.” So we have a range of varying opinions. “According to the New Zealand Bill of Rights”, this other submission says, “point 11 states that Everyone has the right to refuse to undergo any medical treatment [and] enforcing enrolment to a PHO before 6 weeks of age infringes on the right of parents to choose how they care for their newborn’s health. Especially when they are still vulnerable from just having given birth not long ago.” They went on to say that this “stinks of nanny state”.

Also, some submissions are against the fact that vaccinations are tied into the enrolment of newborns, particularly around the six-week time frame, when the first immunisations are due. So those that are against vaccination didn’t like to have that put upon them. Another submission, which I thought was interesting, came from a rural GP obstetrician, which went on to say that “Further imposition of poorly drafted legislation will just add to GP frustration and the on-going exodus [of GPs from rural areas].”

So those are some of the submissions for and against on the bill. I’d just like to refer back to what the previous speaker had to say, regarding measures that have already been put in place to improve newborn enrolment and the fact that more changes are under way. In 2012, the ministry implemented a preliminary enrolment policy to improve newborn enrolments. Now, prior to this policy change, fewer than half of the newborns were enrolled with a general practice by the time they were three months old, and the NES data—that’s the national enrolment system—from October to December in 2017 shows that 75 percent of babies were enrolled by that time. I’d also like to reiterate the point that we heard just previously that the select committee has resolved to monitor to the ministry’s progress towards implementing these actions and achieving better newborn enrolment and the committee is also asking the ministry for updates on its actions with the rates of newborn enrolment in around 12 months’ time.

So, really, it’s just a short contribution from me this evening, as not being part of the Health Committee. I would like to actually make comment that the Newborn Enrolment with General Practice Bill is well-intentioned, and that I would like to extend my sympathy to Dr Parmjeet Parmar for having her member’s bill to this stage. That is something to be proud of, but, really, because she wasn’t able—[Interruption]

ASSISTANT SPEAKER (Poto Williams): Order! Will the member take his seat, please.

—in the last Parliament—to get the previous Minister of Health, Jonathan Coleman, to show any kind of leadership in the health sector, it was unfortunate that she wasn’t able to gather his support at that time. So, just in conclusion, this coalition Government has been clear that we will restore the shortfall that the previous Government left in health. Thank you, Madam Assistant Speaker.

Thank you very much, Madam Assistant Speaker. Well, you know when a Government is in trouble when it has to filibuster a committee stage of a member’s bill that had full support of the House. It even got worse when one member got up and told us her experience of completing an essay at university. I remember the day when the Labour Party was people who had work. They were working people; not pontificating academics telling us how to live. What’s happened to the Labour Party? If a Labour Party doesn’t look out for the vulnerable, who does? That is exactly what the Canterbury District Health Board said. When they put in their submission for this bill, they said legislating this process with shorter time frames will increase the relationship and improve it between the parents and the primary health organisations, particularly for vulnerable population groups.

If the Labour Party and a Labour Government are not going to stick up for vulnerable people, what are they doing? What are they doing in Government? Here we have a bill that they’re voting down purely for political reasons.

Look at the editorial in the Sunday Star-Times by Stacey Kirk on the weekend: “Stealth in health undermining Government—politics the overriding protocol”, and that’s exactly what we had: filibustering a member’s bill that had support across the House. Why? It’s because they don’t want any bills being pulled out of the ballot. Imagine if it was Dr Shane Reti’s medicinal cannabis bill. How embarrassed were they today? It says volumes of a Government that would be embarrassed by members’ bills getting pulled out of the ballot.

Out of every speech we’ve had tonight, not one of those members has provided any evidence why this legislation would not work—not one bit of evidence. What they try and do is recant. Yes, the Ministry of Health said, “We’ve already got a policy in place.” Well, that’s actually proof of why we need this legislation. The policy is only having an enrolment of 75 percent, and sometimes less than 66 percent. On top of that, the Canterbury District Health Board did the work the Government should have done and drilled down on the data, and, in fact, there’s a discrepancy even within the data, because some young people who are presenting as enrolled—2,589 were actually not enrolled. They were nominated for a general practitioner, but had not been enrolled.

All we’re asking for here is that the lead maternity carer sends an enrolment request to a GP and they enrol a young person. How tough is that? And, oh, if they’ve got full workloads, they can re-refer that young person to another GP. That’s all we’re asking for.

I think Stacey Kirk was right: stealth in health undermining Government—politics overriding protocol. That’s exactly what this Government’s doing in voting down this bill and preventing vulnerable young people being enrolled, and why do we know they need to be enrolled? All the evidence shows that if you are enrolled with a GP, immunisation rates go up and health and social outcomes are improved. Tell me one party that doesn’t want that, because I can see three.

Thank you, Madam Deputy Speaker. Well, it’s a pleasure to talk on this bill, which has been a really interesting one for a first-time MP, because it’s the first bill that the Health Committee has actually taken right through the submission stage. It’s been also really interesting because both sides within the Health Committee completely agree on what we want it to achieve. What we want to achieve is all newborn babies enrolled with a general practice by six weeks of age, and also we want to make it as smooth as possible. As you can see by the debate, though, where we diverged is at what we needed to do to do that, because we believe that a lot of the stuff that this bill proposes is actually already happening.

But, first, let’s talk about why we need to enrol babies early. I think the most important thing is getting those first vaccinations in on time, particularly in the case of pertussis, or whooping cough. When I used to work on the children’s wards, we’d often see little babies coming in with pertussis. The problem you’ve got is in the community: a lot of people’s vaccinations sort of wear off and so we don’t have a herd immunity, and these little babies can get really, really sick and they end up in hospital requiring oxygen and they can stay there for weeks at a time. So getting those vaccinations in early is really important.

But the other thing that we want to make sure is that it’s as easy for parents as possible, because the problems you’ve got those first six weeks, even for experienced parents, are particularly challenging. The issue is even for people that have had several kids, getting over a long, difficult birth can take quite a while, establishing that breastfeeding, getting up in the middle of the night, those nightly two-hourly, three-hourly feeds, and also if you’ve got other kids—trying to juggle all of that.

I think the other thing is, if it’s your first time, there are a whole lot of those questions—how do I stop my baby crying; is all that vomiting too much or is that just like normal—and I think, when you’re juggling with all of that in those first six weeks, the last thing you want to do is go through a whole lot of complex paperwork. I think the second thing you’re actually wanting to worry about is—

💬 DEPUTY SPEAKER: Stop bringing me in.

—OK, if indeed—sorry. What parents are worrying about is if indeed that vomiting is actually too much, then who do you go and talk to about it, and you need a primary care practitioner or a GP identified so you can go along.

So we agreed on what we wanted to achieve, but where we diverged is what we want to do about that situation. What we think is that a lot of this is actually happening already, because what the bill is proposing actually duplicates a lot of the processes that already happen when a baby is born and they start to do a pre-enrolment with a GP. So it was interesting listening to some of the submissions.

Thinking through, the two submissions I took most credence from were from the practitioner groups that actually have the most to do with newborn enrolment, and they were the College of Midwives—because they’re there, day in, day out, looking after those mums—and the Royal New Zealand College of General Practitioners. What I want to do is just read you some of the quotes from their submissions.

So what the college of GPs said is, “the College is of the view that the Bill is not necessary. … The Bill is not accompanied by any financial support or incentives.” Further, “there [are] no enforcement mechanisms [or] sanctions, which raise questions about its value. It appears the Bill is primarily a guide, rather than a compulsory measure. Guidance on timeliness of newborn enrolment already exists.”

Similarly, the College of Midwives—because these are the ones that are looking after those mums before baby is born and once baby is born—“the College does is not fully understand what this proposed bill is intending to introduce that is different [from] what already occurs. It appears that the proposed bill is not based on a clear understanding of current processes and structures that are already in place.”

So if new legislation isn’t necessary, then what should we be doing? I think the problem is that much of what the bill proposes actually is already happening. In 2012, they introduced a pre-enrolment system and what that meant is that all newborn babies needed to have their information, including their parents’ preferred GP, entered into the National Immunisation Register (NIR). Then what the NIR does is it automatically pings that GP’s practice and says, “Would you accept this baby?” Then GPs are encouraged to get back within two weeks and accept the baby into their practice, or, if they don’t, then they decline. Before the system was set up, less than half of newborn babies were enrolled with a GP by three months of age, but once the system was in place—by 2017, the latest data we’ve got—75 percent of newborns are now enrolled with a GP by three months of age. So we’ve seen huge improvements over that time just with putting these processes in place.

But there are reasons why we are getting some delays, and that’s probably why not all babies are enrolled by six weeks. Some of them are because the GPs are just a little bit slow in getting back and accepting their patients, but, in other cases, the GP doesn’t actually know the mother, and so they may not wish to take on the patient. We’ve also got a lot of practices where you’ve got a lot of heavy workload, and if the practice is full, then the patients get declined.

The College of Midwives, in their submission, also talked about the fact that you’ve got a lot of families that are moving around a lot, and so it becomes a bit of an issue to get them enrolled with one GP. Also, they were saying that there was a subgroup of families who actually don’t want to engage with health services, and that is their choice.

So the problem we’ve got is that adding a whole layer of legislation on top of this is not likely to fix it because some of the problems are stemming from the fact that we’ve got a shortage of some GPs in some areas, and that’s what’s underpinning the decline rate. In other cases, the question is: can we ethically introduce legislation that forces parents to enrol their babies? We, on this side of the House, don’t think that we want to be doing that.

So what do we actually want to do? Well, our preferred option is for the Ministry of Health to work with district health boards (DHBs), primary health organisations (PHOs) and general practices to continue to improve that timeliness of enrolment. We’ve done that before with things like immunisation rates, where we have concerted efforts and we’re looking at streamlining our processes. At the Health Committee, the ministry had told us that they were already working with PHOs and asking them to get GPs to improve the timeliness of their responses back about whether they can accept a patient. I’ve also said that they want to work—and are working—with DHBs and PHOs so that if the patient gets declined, there are processes in place so that they can find another alternative doctor.

What we think, though, is that in addition just to those measures, we do need to do some other stuff. So there are three other things that we’re recommending that the ministry does. The first of them is introducing some performance measures by the DHBs’ annual plans. What we’re suggesting is that 55 percent of newborns be enrolled with a GP by six weeks and 85 percent by three months. Having worked for many years in the area of monitoring, it’s really interesting to watch how, if things get included in annual plans and they’re actively monitored by the ministry, DHBs do pay attention. This is what happened with the immunisation targets and the immunisation rates. They start to pay attention and say, “Well, how do we work with those practices to improve their performance?” So immunisation saw steady increases, and that’s what I think can happen here.

The other thing we want to look at is the ministry working with DHBs to negotiate clauses in the PHO service agreement that relate to timely newborn enrolment. Finally, what we’re recommending is the ministry implement a whole monitoring and reporting system based on that national enrolment service and makes sure that DHBs can access that so we’ve got up-to-date information on what the proportion of enrolments are across the regions. We think that, as I’ve said, experience with immunisation suggests that we can do this. We just need to work together further.

So just quickly summing up, we think—and we agree across the House—that we need to get babies enrolled with a general practice in those first six weeks of life, and that that process needs to be as simple as possible for parents. But we, on this side of the House, don’t think that putting in place legislation that duplicates what’s already happening but creates no new policy levers is the way to go. We think that we need to continue with the Ministry of Health working with PHOs, DHBs, and GPs to improve timely newborn enrolment. So, unfortunately, we can’t recommend this bill to the House. Thank you.

Thank you, Madam Deputy Speaker. I rise to confirm that the Green Party supports the intentions that have been put forward in this member’s bill, but not the pathway that this piece of legislation is taking. So after the submissions have been made and the work of the Health Committee has been done, we will not be supporting this member’s bill.

Again, we absolutely support the intentions, and, indeed, better social and health outcomes for all tamariki and all babies. We are very clear, after hearing the ministry’s intentions at the select committee hearings and after hearing the submissions, that there is already work and planning in place that’s going to ensure that we are working towards improving social and health outcomes.

So there were a couple of issues that I wanted to pick up in this second reading, given the submissions that have been made. However, in addition to those intentions, I will just quickly put on record for the Green Party that we acknowledge the signalling from the Ministry of Health about their intentions and why, therefore, we have confidence that we are working through a far more efficient and effective way to ensure that we get families, babies, and communities properly connected to healthcare. So I wanted to put on record that with the National Enrolment Service, the Ministry of Health is moving from the current retrospective reporting of enrolments each quarter to using information from the National Enrolment Service.

I acknowledge that the preliminary newborn enrolment with general practice is going to ensure that the ministry is asking primary health organisations (PHOs) to focus on getting general practices to action National Immunisation Register requests—that is, to accept or decline them. I acknowledge that with the DHB accountability framework, the ministry has advised us that it intends to introduce performance measures also as part of the DHB annual plan process in 2018-19. It is important that we note here, tonight, that those performance measures include that 55 percent of newborns will be enrolled with a general practice by six weeks of age and 85 percent of newborns will be enrolled with a general practice by three months of age.

I acknowledged the many signals and steps in the first reading, and when this bill appeared in the previous Government, we signalled that we would support this to select committee. With the current Government, we went through the select committee processes, we went through the submissions, we heard from the submitters and from the responsible ministry, and we are satisfied that there is a better way of upholding the intentions that are evident in this bill.

My contribution tonight is a short call, but I did actually want to pick up on a couple of issues. There were some references made by some of the submitters in terms of the sanctions that might be involved if parents simply did not follow this law and enrol newborns with a practice—with working with lead practitioners. That led me to want to mention tonight, with this bill, that while I understand this bill is not supposed to pick up on a whole lot of other issues that are aligned with improving social and health outcomes for tamariki, I think it’s important that if we are talking about any sort of mandatory enrolment and data collection, we cannot do that without acknowledging what that can also mean in terms of sanctions for those families who, for so many different reasons, may not enrol their children, and we have to acknowledge the issues of why some families may not. A big, glaring one—there should be absolutely no member in this House here tonight, no representative of this House at all, ever, who should not be aware of the glaring cultural inequities that currently exist in our health system, particularly for babies.

So if we are going to talk about mandatory enrolments, then we’d better be very clear about the incredible health inequities that need to be sorted out as well, alongside mandatory enrolments. Pushing ahead immediately with a legislative and a sanction approach to enrolments cannot ignore the lack of culturally appropriate service that is currently a situation that we really have had to do some work on for a long, long time, or ignore asking why it is that some families will be finding it difficult to align and enrol with a PHO or with a healthcare provider. So, you know, I did want to focus on that in my contribution tonight as one of the things that the Greens are certainly wanting to keep in consideration when taking a legislative approach to collecting data—when taking a legislative approach to trying to address social issues in terms of enrolment and data collection without mention or acknowledgment of all of the other access barriers and challenges that sit alongside poor social and health outcomes.

So that was the main point that I wanted to add to the many valid points that have been covered by our Government partners in the House tonight and that I wanted to have a particular voice alongside social and health issues that also need to be considered. We again—to sum up—do acknowledge the positive intentions of this legislation. We look forward to ensuring that the ministry is working through a far more efficient way of making sure that tamariki are getting the healthcare and whānau are getting the healthcare that is appropriate and effective. We will absolutely play our part in holding the ministry to account on those outcomes, as well, and look forward to an update from the ministry on how those intentions are rolling out. Thank you, Madam Deputy Speaker.

The next call is a split call.

Thank you, Madam Deputy Speaker. Not being on the Health Committee, this has been a day—when I found out I was going to be speaking on this bill—of really looking into it and finding out exactly what this bill stood for, and I have to say that I do actually congratulate the member Parmjeet Parmar on the intent of this bill. You cannot argue with the intent of this bill, and we as Government understand that. We know that this bill seeks to improve the health and social outcomes of our young children—of some of our most vulnerable. But the way to deal with our most vulnerable—and here is a fundamental difference between Government and Opposition—is not just to legislate. Just to legislate is not the first option that you go to.

I would actually like to commend the work of the select committee in really digging into this, and this is a perfect example of how powerful select committees are in this Parliament. Select committees are able to go in and really work out what are some of the best approaches to working with our most vulnerable in our country, listening to the experts, listening to the people who know. One of the things that I’ve been doing today is going through those submissions that the select committee had the privilege to listen to, and there are a couple of the submissions that I actually want to highlight here tonight which have pointed out that that legislative approach is not always the best way of actually dealing with our most vulnerable people. It is not the first port of call.

The first submission that I want to point to is from the New Zealand Medical Association, who really agreed—again, like we do—with the intent of the bill. It thought that the intent was good—it’s what we need to look at towards how we’re going to be dealing with our young children, our babies, and getting them enrolled with a GP. But “Rather than pursue”—I’m just quoting from their submission—“a legislative approach to improve newborn enrolment rates, we suggest that it would be useful to gain a better understanding of … reasons why some regions and populations have lower newborn enrolment rates.” Automatically going to—this is me saying that now, not them—the legislative way of dealing with it straight away is not actually going to find out the fundamental root causes of why some demographics and some regions have low enrolment rates of their newborns. That information has to be found out first. You can’t automatically go to putting legislation in place, because that’s not going to change those fundamental root causes.

They go on to say in their submission, “We believe that a quality improvement approach incorporating education and improved communication between all parties is preferable to a legislative approach to this issue.”, and, certainly, as we’ve heard from all of the speakers here on this side of the House tonight, that is already happening. That work is happening with the district health boards and their approach to newborn enrolments, and is the reason why we are seeing such an increase in that particular area.

Another submission that I want to highlight—which follows on from that and follows on from the previous speaker, Marama Davidson, as well—is that from Hāpai te Hauora. They talk about whether the legislative approach is always appropriate for Māori. First of all, what we have to do is actually make sure that we understand why there are lower rates of enrolment within the Māori population. They talk about how going straight away to that legislative approach may actually be, fundamentally, a bad approach for our Māori population, and they have huge concerns. Again, though, they do talk about, in their submission, how the intent of this legislation is good but actually could be more harmful in the end.

I think that those submissions need to be listened to. That’s exactly what we have done on this side of the House. Also, my colleague Dr Liz Craig talked about the submission from the Royal New Zealand College of General Practitioners—people who deal with this on a daily basis are telling the select committee that the bill is not necessary.

We believe in a quality improvement approach. It is happening. We want to see that work continue, but this bill does not do that, so therefore we do not commend it to the House.

Thank you, Madam Deputy Speaker. I rise to take a very brief call on this, and I speak not only in the capacity as a member of Parliament but also as a mother, and also as a lawyer who’s worked with our most vulnerable, highest-deprivation members in the community for the last 30 years. That is not only as counsel for child and advocate for mothers in the court but also as a member of the local district health board that I served on. The concern is that so many of our young mothers and their babies cannot access general practitioner services, and that’s during antenatal care and at the time their babies are born.

I commend Dr Parmjeet Parmar—everyone’s talked about this legislation being well-intentioned. This is practical. This is pragmatic. This is what Whānau Ora is all about. It is about our newborns, our pēpi. It is about our mothers being able to access, through their babies, that necessary health support.

I’ve heard talk in this House this evening about the compliance and the imposition that is there for Māori, or the expectation that Māori would have to do this by way of legislation. This is about extending a helping hand and reaching for those who most need it in our vulnerable communities, requiring the maternity carer to link our most vulnerable, our most needy, those requiring the services of health support practitioners—requiring that that service be provided them. In taking this brief call, it’s disappointing that the importance, need, and recognition of our most needy in the community are being denied by this Government. This is about Whānau Ora, our babies, our mothers, and the wider network within our communities.

It’s truly a privilege to take a short call on this bill, an excellent bill from my colleague Dr Parmjeet Parmar, who I congratulate for getting through to this point.

The goal of this bill has been well enunciated—to increase newborn enrolment with general practitioners before the age of six months—and when you just stand back a bit and look at it for a moment, you’ve got to say, “Why is the Government voting this down?” Just take it on its statement for what it is: why is the Government voting this down? Why is this not a good thing? The benefits have been clear. Again, they were well described, and they were well described through select committee as well: early access to social services, housing, vaccination rates, and early collaboration with other professionals. Again, why is the Government voting this down? Why is this not a good thing?

Now, at first reading, David Clark called the bill toothless because—and the quote’s important here—“there are no penalties for patients who do not do their part in this process on time.” There are no penalties for patients who do not do their part in this process on time—that’s an extraordinary statement. The Minister wants punitive actions for patients who don’t do as they are told.

Surely this is a harbinger for other primary care initiatives this Government is looking to deploy, and remember this mantra when they do. This will be the hook: there are no penalties for patients who do not do their part in this process on time. I think the imposition of penalties is especially ironic when the Government’s removing sanctions from other social service areas, and yet the health Minister is on record saying there should be penalties for patients who do not do their part in this process on time.

💬 Darroch Ball: Oh rubbish! Don’t put words in his mouth. He didn’t say that.

Read it from the first reading. It’s on record. That’s what he’s saying.

💬 Darroch Ball: That’s not what he said.

It’s exactly what he said.

💬 Darroch Ball: No, no, he did not.

Yes, it is. I can show it to you here now. I’m not going to argue. Go and read it, if you can read.

The next point is we’ve just heard from my colleagues and others espousing “Everything’s OK. All is well. We’ve set health targets: 55 percent enrolment at six weeks, 85 percent at three months.”, and we’re told that the ministry will be accountable for that through the district health board (DHB) accountability frameworks and primary health organisations services agreements. Well, several points: am I just hearing “health targets”? Could that possibly be a health target: 55 percent at six weeks and 85 percent at three months? That sounds like a health target to me. But hang on, we’re abolishing health targets. Could this be why we need it to be legislative? If we actually believe in health targets and we don’t want this Government to waive them away like they’re doing in other areas, could this be why it needs to be legislative?

We’ve also been told that the actions can also be done for newborn enrolment—and I’ll read here clause 39 of the departmental report: “Newborn enrolment is chosen by some DHBs as a contributory measure to support system level measure outcomes (SLMs).” Now hang on a minute, hasn’t there been a recent report saying no one understands SLMs and they don’t work? But that’s your answer to the bill? Using something that no one understands and that doesn’t work just does not make sense.

I think a consistent theme was the burden on general practice, and I get that. I guess of everyone in the House I should get that, and I do get it. I can see parts of that. But there was a provision in this bill to cover that. That provision was clause 6(3), which said, “If the nominated general practice is unable to assist the family in finding another primary health care provider, it must refer the pre-enrolment request to the relevant DHB and primary health organisation.” There’s a solution. She’d already come up with a solution to what had been touted by a number of submissions as almost a fall-over issue. Parmjeet Parmar had thought through the answer and it was in her bill.

Look, in conclusion, the Government’s position is “Do nothing; it’s working fine.” Well, I would suggest no, it’s not working fine, and this Government has truly sucked all the imagination out of the room and is actually offering nothing. I’m very sad for newborns, and I think this bill should proceed.

Tēnā koe e te Māngai; otirā ki a koutou katoa kua huihui nei i tēnei pō, o tēnei tū tuatahi o tēnei wā, o tēnei session, nō reira tēnā koutou.

[Thank you, Madam Deputy Speaker; indeed to you all who are gathered here this evening for this first speech of this period, this session, greetings one and all.]

It’s an honour to stand here tonight. Well, it’s actually been a little perplexing, if I’m brutally honest. While I’ve been listening over the past hour or so to my colleagues across the aisle, in particular, as we discuss the well-being of our kids—starting with the most precious, our babies—I am sitting here slightly frustrated with members opposite, because when we are talking about our taonga, our pēpē, it must be the well-being of those tamariki that is at the forefront of any legislation, any policy amendments that we make in this House.

I sat there and I had some pleasant remarks to make about how members’ bills are an opportunity for us, on both sides of the House, to engage on issues that are specific and pertinent to individual members—in this case, the member Parmjeet Parmar—but then I had to listen to my colleague Mr Doocey, who lambasted this side of the House for the lack of care that we show for our kids. He went on some kind of diatribe about the way in which we use the time that we have to make decent laws for our kids, and then he put a couple of questions to us: why would we oppose the Newborn Enrolment with General Practice Bill, which seeks to look after our tamariki in the most vulnerable stages of their lives? “Where is the evidence?”—he implores—“I haven’t heard one member on that side of the House talk about any evidence as to why they’re opposed.” But for every single submission that came in from the medical practitioners—whether they be midwives, or whether they be general practitioners, every single medical association agreed with the intention of the bill, as we all have done tonight, and disagreed implicitly with your approach.

I detest the way the Opposition is playing politics with our tamariki. I absolutely detest the way that you can feel free to kick political balls with our kids. The reality is that if this had been such an important piece of legislation for National—when was this bill introduced? It was May 2017. If this bill was so important to the Opposition that they want to waste our time by making our kids political footballs, you could have done it when you were in blimmin Government, and we all knew that—

💬 DEPUTY SPEAKER: Stop bringing me into the debate.

I apologise to the Deputy Speaker. The Opposition could have done that when they were in Government. [Interruption]

💬 DEPUTY SPEAKER: Order! Order! Can I just remind everyone this is members’ day and members are entitled both to have their say and to bring bills to the House.

I absolutely respect the role of this House to debate the nuances of legislation, and I absolutely agree with the fundamental proposition that we are going to agree and disagree on matters of legislation, but can we please not make our kids the football for political points. I ask that we please not do that.

Now, let me turn to some of my own personal problems with this piece of legislation. What we always were taught—and I commend my colleague from across the House Harete Hipango. She expressed her experience with the law. We all know as lawyers that the only way that you make decent law is if there is a way of enforcing a piece of legislation. In absence of the ability to enforce a piece of legislation, it is but a guideline.

Now, in 2012, the Ministry of Health, under the previous Government, introduced some pretty decent guidelines, and I commend both sides of the House for, I guess, agreeing to and supporting those guidelines. Now, guidelines, we say, with the support of the medical profession—we say—are the most appropriate way for dealing with the way in which we enrol our kids.

In 2012—I better refer to my notes, before I lose my place; I wouldn’t want to do that—the Ministry of Health—

💬 Hon Member: Well, you think you’re funny.

Actually no, to the member that just spoke—and I won’t name her because she’s had her fair share of time for making comments on that side of the House that have gone into the media—these aren’t funny comments. They are actually not funny comments. These comments that I make actually are on the basis of the fact that I’ve just come from a tangi over the last six days for a kid that passed away, because all too often both sides of this House—and for the last nine years, it has been the most vulnerable that have paid the price for arrogance in their attitudes.

💬 DEPUTY SPEAKER: Can you come back to the bill, please?

Absolutely. I turn back to the bill, the Newborn Enrolment with General Practice Bill. I do want to applaud the member opposite for the introduction. I think that the intent was absolutely good, and I think that remark’s been echoed across both sides of the House tonight. I do know, from the remarks that I’ve heard from colleagues that do sit on the Health Committee, that the member who introduced this bill has devoted a lot of time and energy to getting this bill to the particular place it is at. We appreciate the passion that she brings to this legislation.

I also want to acknowledge my colleague Louisa Wall, the chair of the Health Committee, and the member opposite, Shane Reti, the deputy chair. I know that there have been many robust conversations to get this bill to this point. It’s been on the books for just over a year—a year and a half, I think. That brings us to this point.

This side of the House, having considered the medical profession’s perspective and having considered our midwifery profession, have come to the position tonight that we agree with those submissions—the evidence that they’ve put forward. They say that the guidelines that are in place have been appropriate. Labour also has urged the Ministry of Health to proceed with the following actions to improve timely newborn enrolment without the need for legislation: to introduce two performance measures through district health boards (DHBs) in annual plans—that 55 percent of newborns are enrolled with a general practice by six weeks of age, and that 85 percent of newborns are enrolled with a general practice by the age of three months—to continue to work with DHBs to negotiate an appropriate clause in the primary health organisation services agreement requiring timely newborn enrolment, and to implement reporting and monitoring via the National Enrolment Service (NES) and ensure NES enrolment information is accessible to authorised providers such as DHBs.

So, from our side of the House, we do, again, applaud the intent of this bill. We thank the members from across the House for their diligence and for turning their minds to the way in which we most support our children. If I can, please, applaud all of us—let’s look after our kids, and let’s not make them the focus for political footballs, because there’s far too many—

💬 Hon Jacqui Dean: Ha, ha! Ironic.

Ha! There’s far too many of our kids that are falling through the cracks because we choose to make them political footballs, so we will not be supporting this bill through to the third reading. Thank you, Madam Deputy Speaker.

Let me make this very clear: this bill is about protecting our most vulnerable New Zealanders—our newborns—and making sure that they don’t fall through the cracks. It seems to me that the Government members are protesting too much. They should walk the talk. They should actually deliver and take action on the things that they say that they believe in. This bill is about making sure that families are connected into the New Zealand health system quickly so that babies and their families get the best-possible start in life. It’s all about breaking down that inequality of health access for our communities.

My colleague Dr Parmjeet Parmar developed this bill because she was concerned about the low numbers of newborns being enrolled with a general practitioner or a primary health organisation before their six-week immunisation was due. That was something every member of the Health Committee agreed with. Dr Parmar wanted to make sure that families were supported when they had a new baby, and that the health and social support was available from day one, and to make sure that babies didn’t miss out on the protection of that first round of immunisation.

Prevention is the name of the game here. The earlier that GPs can work with newborns and their families, and the earlier we can detect any problems—health or social issues—the better the support we can give to our tamariki. I agree with her—actually, this is just common sense. The birth of a baby is challenging for any family, and by working with new parents early we can protect, we can nurture, and we can look after that baby and its family.

In National, we believe that you can’t manage what you don’t measure. That’s why we wanted to see a target in legislation, so that it was clear to everybody—clear to members of the medical profession, clear to families—just how important this early enrolment is. Research tells us that the post-natal period is one of the most important opportunities for influencing health and well-being, and, actually, the long-term health of babies and their families. Immunisations are the key, important way to protect babies, going forward. New Zealand is known for the high quality of our health services and targets that have been instrumental in driving these improvements in the last few years, since they were established back in 2007, and that’s why we’re so concerned that this Government is dumping them.

It’s interesting what’s happened to immunisation because of the immunisation targets. They’ve driven up the number of babies getting protected. Back in 2008, the target was only 85 percent of babies being immunised by eight months. That was a significant challenge because, at that time, we were only actually immunising about 70 percent. It’s important that we continue to raise that. One of the key reasons why I bring this up is because it’s immunisation and getting communities behind immunisation that has raised the quality of what’s happening for our babies in the long term.

All district health boards have been reporting against these stats, so we’ve been able to identify where we are doing well in the country. One of the things that have been the most exciting about this is that communities have taken these targets to their hearts, and some of the communities that had low levels of immunisation have actually become the stars—and the Pasifika community is one of those. So it’s hugely disappointing that this Government doesn’t support this bill, although most submitters felt that it was important and the ministry itself was keen to increase the numbers of babies getting enrolled in those first six weeks. It seems that politics has got in the way of a good health practice.

So, finally, I would like to thank Dr Parmar for her work. It’s really unfortunate that the Government members of the committee weren’t prepared to walk the talk. They weren’t prepared to support this common-sense, practical way of looking after our most vulnerable newborns—hugely disappointing.